What is the effect of interrupting prolonged sitting with frequent bouts of physical activity or standing on first or recurrent stroke risk factors? A scoping review

The objective of this review was to ascertain the scope of the available literature on the effects of interrupting prolonged sitting time with frequent bouts of physical activity or standing on stroke and recurrent stroke risk factors. Databases Medline, Embase, AMED, CINAHL and Cochrane library were comprehensively searched from inception until 21st February 2018. Experimental trials which interrupted sitting time with frequent bouts of physical activity or standing in adults (≥ 18 years) were included. Comparison to a bout of prolonged sitting and a measure of at least one first or recurrent stroke risk factor was required to be included. Overall, 30 trials (35 articles) were identified to meet the inclusion criteria. Fifteen trials were completed in participants at an increased risk of having a first stroke and one trial in participants at risk of a recurrent stroke. Outcomes of hypertension and dysglycemia were found to be more favourable following predominately light- to moderate-intensity bouts of physical activity or standing compared to sitting in the majority of trials in participants at risk of having a first stroke. In the one trial of stroke survivors, only outcomes of hypertension were significantly improved. These findings are of significant importance taking into consideration hypertension is the leading risk factor for first and recurrent stroke. However, trials primarily focused on measuring outcomes of dysglycemia and without assessing a dose-response effect. Additional research is required on the dose-response effect of interrupting sitting with frequent bouts of physical activity or standing on first and recurrent stroke risk factors, in those high risk population groups

Unlocking the puzzle: a narrative inquiry into the experiences of people with transient ischaemic attack or minor stroke

Research Doctorate - Doctor of Philosophy (PhD)Transient ischaemic attack and minor stroke are medical emergencies and significant warning signs for stroke. To date, much of the research attention has been focused on identifying the most beneficial pathway of healthcare for people with transient ischaemic attack or minor stroke. Yet, little is known about the lived experiences of transient ischaemic attack and minor stroke or how these experiences are shaped by health services. In this thesis, a narrative inquiry was undertaken to explore the experiences of twelve individuals with transient ischaemic attack or minor stroke. Data was collected in one, face-to-face, semi-structured interview. To analyse the participant stories, an extension of the narrative inquiry methodology was developed that explores both individual experiences and the commonalities between experiences within the temporal, social, and place domains of narrative inquiry. Through their stories of experience, novel insights were revealed including an altered perception of time, the roles of others in help-seeking, and the impact of living with a disrupted body. Furthermore, exploring their experiences led to the recognition of a grieving process and the development of a new model of grief that perceives grief in liminal spaces. Healthcare pathways also shaped participant experiences of transient ischaemic attack and minor stroke through their current and past interactions. Thus, every interaction with healthcare services informed their future decisions and behaviours. Importantly, exploring these interactions led to my discovery of a new theory of help-seeking behaviour that explains why some individuals seek help while others do not. In this thesis, the stories of twelve individuals with transient ischaemic attack and minor stroke, and the commonalities between their stories, are explored, relived and retold. In doing so, the intricacy and complexity of their transient ischaemic attack and minor stroke experiences are revealed

The effects of interrupting prolonged sitting with frequent bouts of light-intensity standing exercises on blood pressure in stroke survivors : A dose escalation trial

Background: Interrupting prolonged sitting acutely lowers blood pressure in nonstroke populations. However, the dose–response effect in stroke survivors is unknown. The authors investigated different doses of light-intensity standing exercises that interrupt prolonged sitting and reduce blood pressure immediately and over 24 hours in stroke survivors. Methods: Within-participant, laboratory-based, dose escalation trial. Conditions (8 h) were prolonged sitting and 2 experimental conditions of standing exercises with increasing frequency (3 cohorts, 2 × 5 min to 6 × 5 min). The primary outcome is the mean systolic blood pressure. Results: Twenty-nine stroke survivors (aged 66 [12] y) participated. Frequent bouts of standing exercises lowered the mean systolic blood pressure following the 4 × 5-minute (−2.1 mm Hg; 95% confidence interval [CI], −3.6 to −0.6) and 6 × 5-minute conditions (−2.3 mm Hg; 95% CI, −4.2 to −0.5) compared with prolonged sitting. Diastolic blood pressure was lowered following the 6 × 5-minute condition (−1.4 mm Hg; 95% CI, −2.7 to −0.2). The 24-hour systolic blood pressure increased following the 2 × 5-minute condition (6.9 mm Hg; 95% CI, 3.1 to 10.6). Conclusions: Interrupting prolonged sitting with more frequent bouts of standing exercises lowers systolic and diastolic blood pressure in stroke survivors. However, reductions may only be short term, and investigations on sustained effects are warranted

Acute effects of frequent light-intensity standing-based exercises that interrupt 8 hours of prolonged sitting on postprandial glucose in stroke survivors : A dose-escalation trial

Background: Interrupting prolonged sitting can attenuate postprandial glucose responses in overweight adults. The dose–response effect in stroke survivors is unknown. The authors investigated the effects of interrupting 8 hours of prolonged sitting with increasingly frequent bouts of light-intensity standing-based exercises on the postprandial glucose response in stroke survivors. Methods: Within-participant, laboratory-based, dose-escalation trial. Participants completed three 8-hour conditions: prolonged sitting and 2 experimental conditions. Experimental conditions involved light-intensity standing-based exercises of increasing frequency (2 × 5 min to 6 × 5 min bouts). Postprandial glucose is reported. Results: Twenty-nine stroke survivors (aged 66 y) participated. Interrupting 8 hours of prolonged sitting with light-intensity standing-based exercises every 90 minutes significantly decreased postprandial glucose (positive incremental area under the curve; −1.1 mmol/L·7 h; 95% confidence interval, −2.0 to −0.1). In the morning (08:00–11:00), postprandial glucose decreased during the 4 × 5 minutes and 6 × 5 minutes conditions (positive incremental area under the curve; −0.8 mmol/L·3 h; 95% confidence interval, −1.3 to −0.3 and −0.8 mmol/L·3 h; 95% confidence interval, −1.5 to −0.2, respectively) compared with prolonged sitting. Conclusion: Interrupting 8 hours of prolonged sitting at least every 90 minutes with light-intensity standing-based exercises attenuates postprandial glucose in stroke survivors. During the morning, postprandial glucose is attenuated when sitting is interrupted every 60 and 90 minutes

Lasting impairments following transient ischemic attack and minor stroke: a systematic review protocol

INTRODUCTION: The focus on medical management and secondary prevention following Transient Ischemic Attack (TIA) and minor stroke is well-established. Evidence is emerging that people with TIA and minor stroke can experience lasting impairments as fatigue, depression, anxiety, cognitive impairment, and communication difficulties. These impairments are often underrecognized and inconsistently treated. Research in this area is developing rapidly and an updated systematic review is required to evaluate new evidence as it emerges. This living systematic review aims to describe the prevalence of lasting impairments and how they affect the lives of people with TIA and minor stroke. Furthermore, we will explore whether there are differences in impairments experienced by people with TIA compared to minor stroke. METHODS: Systematic searches of PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Libraries will be undertaken. The protocol will follow the Cochrane living systematic review guideline with an update annually. A team of interdisciplinary reviewers will independently screen search results, identify relevant studies based on the defined criteria, conduct quality assessments, and extract data. This systematic review will include quantitative studies on people with TIA and/or minor stroke that report on outcomes in relation to fatigue, cognitive and communication impairments, depression, anxiety, quality of life, return to work/education, or social participation. Where possible, findings will be grouped for TIA and minor stroke and collated according to the time that follow-up occurred (short-term 12 months). Sub-group analysis on TIA and minor stroke will be performed based on results from the included studies. Data from individual studies will be pooled to perform meta-analysis where possible. Reporting will follow the Preferred Reporting Items for Systematic review and Meta-Analysis Protocol (PRISMA-P) guideline. PERSPECTIVES: This living systematic review will collate the latest knowledge on lasting impairments and how these affect the lives of people with TIA and minor stroke. It will seek to guide and support future research on impairments emphasizing distinctions between TIA and minor stroke. Finally, this evidence will allow healthcare professionals to improve follow-up care for people with TIA and minor stroke by supporting them to identify and address lasting impairments

Investigating the rigour of research findings in experimental studies assessing the effects of breaking up prolonged sitting - extended scoping review

Objectives Sedentary behaviour research is a relatively new field, much of which has emerged since the widespread acceptance of clinical trial registration. The aim of this study was to investigate the trial registration and related issues in studies investigating the effect of frequent activity interruptions to prolonged sitting-time. Methods Secondary analysis of a scoping review including systematic searches of databases and trial registries. We included experimental studies investigating the effects of frequent activity interruptions to prolonged sitting-time. Results We identified 32 trials published in 45 papers. Only 16 (50%) trials were registered, with all 16 trials being completed and published. Of the unregistered trials, we identified three (19%) for which similarities in the sample size and participant demographics across papers was suggestive of duplicate publication. Identification of potential duplicate publications was difficult for the remaining 13 (81%). Results from 53 (76%) of the 70 registered outcomes were published, but 11 (69%) registered trials reported results from additional outcomes not prospectively registered. A total of 46 different outcomes (out of 53 reported outcome measures, similar measures were collated) were reported across all trials, 31 (67%) of which were collected in ≤2 trials. Conclusions We found direct evidence of trial registration issues in experimental trials of breaking up sitting-time. The lack of prospective registration of all trials, and the large number of outcomes measured per trial are key considerations for future research in this field. These issues are unlikely to be confined to the field of sedentary behaviour research

Frequent, short bouts of light-intensity exercises while standing decreases systolic blood pressure: breaking up sitting time after stroke (BUST-Stroke) trial

Background: Stroke survivors sit for long periods each day. Uninterrupted sitting is associated with increased risk of cardiovascular disease. Breaking up uninterrupted sitting with frequent, short bouts of light-intensity physical activity has an immediate positive effect on blood pressure and plasma clotting factors in healthy, overweight, and type 2 diabetic populations. Aim: We examined the effect of frequent, short bouts of light-intensity physical activity on blood pressure and plasma fibrinogen in stroke survivors. Methods: Prespecified secondary analyses from a three-armed randomized, within-participant, crossover trial. Participants were 19 stroke survivors (nine female, aged 68 years old, 90% able to walk independently). The experimental conditions were sitting for 8 h uninterrupted, sitting with 3 min bouts of light-intensity exercise while standing every 30 min, or sitting with 3 min of walking every 30 min. Blood pressure was measured every 30 min over 8 h and plasma fibrinogen at the beginning, middle, and end of each day. Intention-to-treat analyses were performed using linear mixed models including fixed effects for condition, period, and order, and a random intercept for participant to account for repeated measures and missing data. Results: Sitting with 3 min bouts of light-intensity exercise while standing every 30 min decreased systolic blood pressure by 3.5 mmHg (95% CI 1.7–5.4) compared with sitting for 8 h uninterrupted. For participants not taking antihypertensive medications, sitting with 3 min of walking every 30 min decreased systolic blood pressure by 5.0 mmHg (95% CI −7.9 to 2.0) and sitting with 3 min bouts light-intensity exercise while standing every 30 min decreased systolic blood pressure by 4.2 mmHg (95% CI −7.2 to −1.3) compared with sitting for 8 h uninterrupted. There was no effect of condition on diastolic blood pressure (p = 0.45) or plasma fibrinogen levels (p = 0.91). Conclusion: Frequent, short bouts of light-intensity physical activity decreases systolic blood pressure in stroke survivors. However, before translation into clinical practice, the optimal duration and timing of physical activity bouts needs to be determined. Clinical trial registration: Australian and New Zealand Clinical Trials Registry http://www.anzctr.org.au ANZTR12615001189516

Lasting impairments following transient ischemic attack and minor stroke: a systematic review protocol

IntroductionThe focus on medical management and secondary prevention following Transient Ischemic Attack (TIA) and minor stroke is well-established. Evidence is emerging that people with TIA and minor stroke can experience lasting impairments as fatigue, depression, anxiety, cognitive impairment, and communication difficulties. These impairments are often underrecognized and inconsistently treated. Research in this area is developing rapidly and an updated systematic review is required to evaluate new evidence as it emerges. This living systematic review aims to describe the prevalence of lasting impairments and how they affect the lives of people with TIA and minor stroke. Furthermore, we will explore whether there are differences in impairments experienced by people with TIA compared to minor stroke.MethodsSystematic searches of PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Libraries will be undertaken. The protocol will follow the Cochrane living systematic review guideline with an update annually. A team of interdisciplinary reviewers will independently screen search results, identify relevant studies based on the defined criteria, conduct quality assessments, and extract data. This systematic review will include quantitative studies on people with TIA and/or minor stroke that report on outcomes in relation to fatigue, cognitive and communication impairments, depression, anxiety, quality of life, return to work/education, or social participation. Where possible, findings will be grouped for TIA and minor stroke and collated according to the time that follow-up occurred (short-term < 3 months, medium-term 3–12 months, and long-term > 12 months). Sub-group analysis on TIA and minor stroke will be performed based on results from the included studies. Data from individual studies will be pooled to perform meta-analysis where possible. Reporting will follow the Preferred Reporting Items for Systematic review and Meta-Analysis Protocol (PRISMA-P) guideline.PerspectivesThis living systematic review will collate the latest knowledge on lasting impairments and how these affect the lives of people with TIA and minor stroke. It will seek to guide and support future research on impairments emphasizing distinctions between TIA and minor stroke. Finally, this evidence will allow healthcare professionals to improve follow-up care for people with TIA and minor stroke by supporting them to identify and address lasting impairments